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Exploring the barriers of adherence to dietary recommendations among patients with type 2 diabetes: A qualitative study in Iran.

ABSTRACT: Aims:Type 2 diabetes is a major global health concern, and its prevalence is rapidly increasing throughout the world. The present study was conducted to explore the experiences of patients and healthcare providers to identify the social barriers to patients' adherence to their recommended diet and thus help the design of future interventions. Design:This study was conducted as a qualitative study with content analysis approach. Methods:The present qualitative study was conducted from November 2016-July 2017. Data were collected through 38 unstructured in-depth interviews with 33 T2D patients and their treatment supervisors and field notes. The interview transcripts were coded using the MAXQDA 10 software. To extract categories and themes, the thematic analysis approach was used. We followed the COREQ Checklist to ensure rigour in our study. Results:The analysis of the study revealed the emergence of five categories of perceived barriers including social priorities and rivalries, family's food habits, poor social support, social impasses and dominant food patterns.

SUBMITTER: Mostafavi-Darani F

PROVIDER: S-EPMC7544840 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Exploring the barriers of adherence to dietary recommendations among patients with type 2 diabetes: A qualitative study in Iran.

Mostafavi-Darani Firoozeh F Zamani-Alavijeh Fereshteh F Mahaki Behzad B Salahshouri Arash A

Nursing open 20200716 6

<h4>Aims</h4>Type 2 diabetes is a major global health concern, and its prevalence is rapidly increasing throughout the world. The present study was conducted to explore the experiences of patients and healthcare providers to identify the social barriers to patients' adherence to their recommended diet and thus help the design of future interventions.<h4>Design</h4>This study was conducted as a qualitative study with content analysis approach.<h4>Methods</h4>The present qualitative study was cond ...[more]

PMID: 33072357

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Project description:BackgroundDiabetes self-management education, a universally recommended component of diabetes care, aims to support self-management in people with type 2 diabetes. However, attendance is low (approx. 10%). Previous research investigating the reasons for low attendance have not yet linked findings to theory, making it difficult to translate findings into practice. This study explores why some adults with type 2 diabetes do not attend diabetes self-management education and considers how services can be adapted accordingly, using Andersen's Behavioural Model of Health Service Utilisation as a framework.MethodsA cross-sectional semi-structured qualitative interview study was carried out. Semi-structured interviews were conducted by telephone with 14 adults with type 2 diabetes who had verbally declined their invitation to attend diabetes self-management education in Bath and North East Somerset, UK, within the last 2 years. Data were analysed using inductive thematic analysis before mapping the themes onto the factors of Andersen's Behavioural Model.ResultsTwo main themes were identified: 'perceived need' and 'practical barriers'. The former theme explored participants' tendency to decline diabetes education when they perceived they did not need the programme. This perception tended to arise from participants' high self-efficacy to manage their type 2 diabetes, the low priority they attributed to their condition and limited knowledge about the programme. The latter theme, 'practical barriers', explored the notion that some participants wanted to attend but were unable to due to other commitments and/or transportation issues in getting to the venue.ConclusionsAll sub-themes resonated with one or more factors of Andersen's Behavioural Model indicating that the model may help to elucidate attendance barriers and ways to improve services. To fully understand low attendance to diabetes education, the complex and individualised reasons for non-attendance must be recognised and a person-centred approach should be taken to understand people's experience, needs and capabilities.

Project description:Background:Adherence by diabetic patients to dietary recommendations is important for effective therapy. Considering patients' expectations in case of diet is significant in this regard. The aim of this paper was to analyze the relationship between selected independent variables (eg, regular blood glucose testing) and patients' adherence to dietary recommendations, bearing in mind that the degree of disease acceptance might play a mediation role. Subjects and methods:A cross-sectional study was conducted in 91 patients treated for type 2 diabetes mellitus in a public medical facility. Paper-and-pencil interviewing was administered ahead of the planned visit with a diabetes specialist. Two measures were applied in the study: the Acceptance and Action Diabetes Questionnaire and the Patient Diet Adherence in Diabetes Scale. Additionally, data related to sociodemographic characteristics, lifestyle-related factors, and the course of the disease (management, incidence of complications, and dietician's supervision) were also collected. The regression method was used in the analysis, and Cohen's methodology was used to estimate partial mediation. Significance of the mediation effect was assessed by the Goodman test. P-values of <0.05 were considered statistically significant. Results:Patients' non-adherence to dietary recommendations was related to a low level of disease acceptance (standardized regression coefficient =-0.266; P=0.010). Moreover, failure to perform regular blood glucose testing was associated with a lack of disease acceptance (standardized regression coefficient =-0.455; P=0.000). However, the lack of regular blood glucose testing and low level of acceptance had only partially negative impacts on adherence to dietary recommendations (Goodman mediation test, Z=1.939; P=0.054). This dependence was not seen in patients treated with diet and concomitant oral medicines and/or insulin therapy. Conclusion:Effective dietary education should include activities promoting a more positive attitude toward the disease. This may be obtained by individual counseling, respecting the patient's needs, and focus on regular blood glucose testing.

Project description:Protein-energy wasting (PEW) is considered one of the major complications of chronic kidney disease (CKD), particularly in dialysis patients. Insufficient energy and protein intake, together with clinical complications, may contribute to the onset and severity of PEW. Therefore, the aim of the study was to analyze the differences in nutritional and hydration status and dietary intake among Dalmatian dialysis patients. Fifty-five hemodialysis (HD) and twenty peritoneal dialysis (PD) participants were included. For each study participant, data about body composition, anthropometric, laboratory, and clinical parameters were obtained. The Malnutrition Inflammation Score (MIS) and two separate 24-h dietary recalls were used to assess nutritional status and dietary intake. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated to compare actual dietary intake with recommended intake. Additionally, the estimated 10-year survival was calculated using the Charlson Comorbidity Index. The prevalence of malnutrition according to MIS was 47.3% in HD and 45% in PD participants. Significant differences in fat tissue parameters were found between HD and PD participants, whereas significant differences in hydration status and muscle mass parameters were not found. A significant difference in NAR between HD and PD participants was noticed for potassium and phosphorus intake, but not for MAR. MIS correlated negatively with anthropometric parameters, fat mass, visceral fat level and trunk fat mass, and iron and uric acid in HD participants, whereas no significant correlations were found in PD participants. The estimated 10-year survival correlated with several parameters of nutritional status in HD and PD participants, as well as nutrient intake in HD participants. These results indicate a high prevalence of malnutrition and inadequate dietary intake in the Dalmatian dialysis population which, furthermore, highlights the urgent need for individualized and structural nutritional support.

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Exploring the barriers of adherence to dietary recommendations among patients with type 2 diabetes: A qualitative study in Iran.

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Exploring the barriers of adherence to dietary recommendations among patients with type 2 diabetes: A qualitative study in Iran.

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